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General NPI Number Information
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NPI Number | 1851628879
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Entity Type | Organization
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Legal Business Name | PRIMROSE MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 3724 W QUIET CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-2053
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Country | US
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Telephone | 303-981-4078
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 QUIET CIRCLE W.
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917
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Country | US
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Telephone | 303-981-4078
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | ELLA GOLDBLAT
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Credential | RN, BSN
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Telephone | 303-981-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 163204
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License Number State | CO
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